Psychiatric and substance use disorders are common in hepatitis C patients
and represent a barrier to antiviral treatment. In particular, some studies
have shown that individuals with a history of psychiatric conditions and
substance use are more likely to experience depression as a side effect of
interferon-based therapy.

As reported in the October 2006 American Journal of Gastroenterology,
researchers with the Veterans Affairs Medical Center in Minneapolis
retrospectively evaluated the effect of integrating psychiatric and medical
care on evaluation for and initiation of antiviral treatment in a cohort of
184 patients with chronic hepatitis C.

Integrated care consisted of screening for psychiatric problems using the
Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), Beck
Depression Inventory (BDI), and Primary Care Posttraumatic Stress Disorder
(PC-PTSD) screens, as well as urine drug tests. Based on specific cut-off
scores, patients were referred to an established mental health provider, to
a co-located psychiatric clinical nurse specialist, or both.

Results

Most patients (149 out of 184; 81.0%) had at
least 1 positive mental health screening result, and 25.5% had a positive
urine drug test.

Among patients with positive mental health
screens, 38.3% had established mental health providers, 47.0% had no mental
health provider and were referred to the psychiatric clinical nurse
specialist, and 15.0% refused any psychiatric referral.

Patients receiving integrated care with a
co-located psychiatric nurse specialist were significantly more likely to
complete evaluation for and start antiviral treatment than other patients
with positive screens, and at a rate similar to that of patients with
negative mental health screens.

Patients with positive screens followed by any
mental health provider had significantly greater adherence to antiviral
therapy than patients without positive screens.

Conclusion

"An integrated mental
health and medical approach was associated with rates of antiviral therapy
recommendation and initiation similar to patients without risks for
psychiatric or substance use problems," the authors concluded. "Mental
health care was associated with improved adherence to antiviral therapy.
Integrated care offers promise as an approach for addressing psychiatric
comorbidity in this traditionally difficult to treat population."